For many years, the
Division of Vascular and Endovascular Surgery at UC San Diego’s School of Medicine has provided cutting edge treatment for the entire spectrum of vascular disease; conducted advanced research; and trained the next generation of vascular surgeons. Now, the division is increasingly investigating the potentials of minimally invasive surgery with endovascular techniques to redefine how surgery is performed.

“Vascular surgery has been undergoing a revolution over the last several years,” says
Dr. John Lane, interim chief of the Division of Vascular and Endovascular Surgery, “as the discipline has transitioned from a traditional, open surgical approach to vascular disease, to minimally invasive approaches, with huge benefits for patients—simplified procedures, and faster recovery. This is really a paradigm shift and our institution has been at the forefront in adopting these new techniques.”

At this year’s SCVSS annual meeting, vascular division trainees gave 4 presentations on the advanced endovascular and hybrid techniques being used at UCSD to combat vascular disease. Their articles will be published in the June edition of the Annals of Vascular Surgery, an edition dedicated to the SCVSS.

The Vascular Division is a leader in clinical trials and new technology. Currently there are 2 clinical trials involving novel grafts for endovascular aneurysm repair, at San Diego VA. Both trials, NELLIX and EVEVATE, involve the use of polymer technology for aneurysm sealing. We are also involved with the NIH-sponsored BEST-CLI trial, which examines the long-term effectiveness of endovascular and open surgical bypass for the treatment of critical limb ischemia (poor leg circulation).

The Division is also the lead referral center in the region, specializing in complex procedures. These procedures result—not only in positive outcomes for patients—but also a wealth of learning among faculty and trainees, which can be applied to future cases. With this in the mind, the Division is launching Clinical Challenges: Cases in Vascular Surgery. “The purpose of the series,” says Lane, “is to showcase our most interesting, challenging and important cases, and in doing so, share what we’re learning and strengthen the community of practice.”

The first case reviews experience tackling an infected aortic endograft, a feared complication with a multidisciplinary solution.

From the case:

“Enlargement of the aorta in the abdomen (referred to as an abdominal aortic aneurysm, or AAA) is the cause of approximately ten thousand deaths per year in the United States. The most common method of treatment employs a stentgraft, deployed through small punctures in the femoral arteries, to exclude the blood flow from the enlarged portion and prevent rupture. Although the chances of infection of the stentgraft are only about one percent, patients whose grafts become infected are at a very high risk of death from infection (50-100% mortality). Treatment of the patient with an infected endograft often requires careful planning and the involvement of multiple medical and surgical specialties to provide salvage and rehabilitation from a life-threatening disease.”